CAJ | 학술논문

目的：随着显微外科技术的发展和普及，在头颈肿瘤术后缺损的修复中胸大肌肌皮瓣(PMMF)已逐渐被游离组织瓣替代，但是对于不愿意或不适合进行游离瓣移植的患者，对于不具备显微外科技术的单位，PMMF依旧是可靠的修复方法之一。本研究评价PMMF修复头颈部缺损术后供区的外观满意度、感觉和运动等功能，为选择PMMF修复头颈部软组织缺损提供理论依据。方法应用问卷调查的方法随访应用PMMF修复头颈部缺损的32例患者，评价手术对供区外观满意度、感觉及运动功能的影响。结果所有患者供区术口均能一期拉拢缝合或采用临位皮瓣转移错位缝合，无明显近期并发症。所有患者术后均未发生与胸大肌切断引起的上肢淋巴水肿、感觉异常及功能障碍。56.3%（18/32）的患者对供区术后肩关节运动满意，男性满意度较女性低，但差异无统计学意义。53.1%（17/32）的患者对术后供区外观满意，女性患者的满意度较男性低，且差异有统计学意义(P<0.05)。59.4%（19/32）的患者对术后供区胸壁皮肤感觉满意，女性患者的满意度较男性低，但差异无统计学意义。25.0%（8/32）的患者对术后供区乳头感觉满意，女性患者的满意度较男性高，且差异有统计学意义(P<0.05)。结论选择PMMF修复头颈部缺损对胸部供区、肩关节运动和同侧上肢功能的影响有限，对男性乳头感觉有影响，对女性胸壁皮肤感觉和外观有影响，但均可以被患者接受。
목적：수착현미외과기술적발전화보급，재두경종류술후결손적수복중흉대기기피판(PMMF)이축점피유리조직판체대，단시대우불원의혹불괄합진행유리판이식적환자，대우불구비현미외과기술적단위，PMMF의구시가고적수복방법지일。본연구평개PMMF수복두경부결손술후공구적외관만의도、감각화운동등공능，위선택PMMF수복두경부연조직결손제공이론의거。방법응용문권조사적방법수방응용PMMF수복두경부결손적32례환자，평개수술대공구외관만의도、감각급운동공능적영향。결과소유환자공구술구균능일기랍롱봉합혹채용림위피판전이착위봉합，무명현근기병발증。소유환자술후균미발생여흉대기절단인기적상지림파수종、감각이상급공능장애。56.3%（18/32）적환자대공구술후견관절운동만의，남성만의도교녀성저，단차이무통계학의의。53.1%（17/32）적환자대술후공구외관만의，녀성환자적만의도교남성저，차차이유통계학의의(P<0.05)。59.4%（19/32）적환자대술후공구흉벽피부감각만의，녀성환자적만의도교남성저，단차이무통계학의의。25.0%（8/32）적환자대술후공구유두감각만의，녀성환자적만의도교남성고，차차이유통계학의의(P<0.05)。결론선택PMMF수복두경부결손대흉부공구、견관절운동화동측상지공능적영향유한，대남성유두감각유영향，대녀성흉벽피부감각화외관유영향，단균가이피환자접수。
Objective With the development of microsurgical technique and popularity, pectoralis major myocutaneousflap (PMMF) has been gradually replaced by free tissueflap in the head and neck cancer postoperative defect repair (or in the reconstruction of massive defects after head and neck tumor excision). But for not willing to or be notfit for freeflap transplantation patients, or hospital not have the microsurgical technique, PMMF still is one of the reliable repairMethods The study evaluated the exterior satisfaction, sensory and motor functions of donor site, and provide the theoretical basis for the PMMF in the reconstruction of massive defects after head and neck tumor excision.Methods Questionnaire was used to fellow up 32 patients with head and neck reconstruction using PMMF from January 2008 and December 2012 in Ganzhou tumor hospital. The exterior satisfaction, sensory and motor functions of donor site was evaluated.Results Donor site wounds were primarily closed or using a dislocated sutureflap transposition in all patients without evident early complications. The upper limb lymphedema, paraesthesia and dysfunction caused by pectoralis major cut was not influenced in all patients. A total of 56.3% (18/32) of patients satisfied with the postoperative shoulder joint movement ,male patients had lower satisfaction than female, However, there was no statistically significant difference. And 53.1% (17/32) of patients answered satisfaction for appearance, conversely, female patients had lower satisfaction than male, and there was statistically significant difference between them. A total of 59.4% (19/32) of patients answered satisfaction for the postoperative chest wall skin sensation, female patients had lower satisfaction than male, but there was no statistically significant difference. 25.0% (8/32) of patients satisfied with the postoperative nipples feel, female patients had higher satisfaction than male, and there was statistically significant difference.Conclusion The application of PMMF in reconstruction of head and neck defects influences the function of donor site, the same side upper limb and shoulder joint motion limited. Had an effect on male nipples feeling, female Chest wall skin feeling and appearance, however, all can be accepted by patients.